RPD-41205
Rev. 02/27/2024                           New Mexico Taxation and Revenue Department
                                                 Holder's Negative Report 
                                                 Unclaimed Property Office 
                                                 P.O. Box 25123 
                                                 Santa Fe, New Mexico 87504-5123

Section 1 Holder Information
1. Name of Holder                                                                              2. FEIN, SSN, or ITIN

3. Mailing Address - City, State, Zip Code

4. Name of Contact Person                                          5. Contact Phone Number

6. Contact Email Address

Section 2 Negative Report

The above named holder has no unclaimed property to file with the state of New Mexico for the,                           annual report year of the period

ending June 30

Section 3 Signature
I declare that I have examined this report and, to the best of my knowledge and belief, it is true, correct and complete.
7. Printed Name                                                                                8. Title

9. Signature                                                                                   10.  Date

                                                 Instructions
Negative Reports                                                   6.  Contact Email Address
If the holder has no unclaimed property to report, the holder         Enter contact person's email address.
will need to file Form RPD-41205, Holder's Negative Report, 
on November 1, or May 1 for life insurance companies. When-        Section 2
ever possible, the negative reports should be filed online at      Enter the report year and enter the period ending year ap-
https://holdernm.unclaimed property.com/                           plicable to this report

Starting May of 2022, negative report filing is no longer required Section 3
from out-of-state holders who filed negative reports for the       7.  Printed Name
past three consecutive years. However, the holder is able to          Enter the printed name of signer.
file the negative reports if they would like to.                   8.  Title
                                                                      Enter the title of signer.
If the holder never acquired unclaimed property and currently      9.  Signature
does not have funds to report, do not file the negative report.       Enter signature.
                                                                   10. Date
Section 1                                                             Enter the date this form is signed. Use the date format 
1.  Name of Holder                                                    mm/dd/ccyy.
   Enter the name of the holder.
2.  FEIN, SSN, or ITIN                                             If you have any questions please contact the Unclaimed 
   Enter the FEIN, SSN, or ITIN of the holder.                     Property Office at:
3.  Mailing Address - City, State, and Zip Code
   Enter the mailing address of the holder.                           New Mexico Taxation & Revenue Department
4.  Name of Contact Person                                                                     Unclaimed Property Office
   Enter contact person's name.                                                                   P.O. Box 25123
5.  Contact Phone Number                                                    Santa Fe, New Mexico 87504-5123
   Enter contact person's phone number.                                         Unclaimed.Property@tax.nm.gov
                                                                                                  505-827-0668